Psychotherapy, Meds Best for Youth With Obsessive Compulsive Disorder
Children and adolescents with Obsessive Compulsive Disorder (OCD)
respond best to a combination of both psychotherapy and an antidepressant,
a major clinical trial has found. Supported by the National Institutes
of Health’s (NIH) National Institute of Mental Health, the
study recommends that treatment begin with cognitive behavior therapy
(CBT), either alone or with a serotonin reuptake inhibitor (SSRI)
antidepressant. The research spotlights the need for improved access
to CBT, since most young people with OCD currently receive only
the antidepressant, often combined with an antipsychotic medication.
John March, M.D., Duke University, Edna Foa, Ph.D., University
of Pennsylvania, and colleagues report on the findings of the Pediatric
OCD Treatment Study (POTS) in the October 27, 2004 Journal of the
American Medical Association (JAMA).
Ninety-seven 7-17 year-olds with OCD completed 12 weeks of treatment
with either CBT, the SSRI sertraline, the combination treatment,
or a placebo. Independent evaluators, blind to their treatment
status, assessed each patient every four weeks. Patients in the
study were typical of patients seen in clinical practice. For example,
while industry-sponsored trials commonly exclude patients with
more than one condition, 80 percent of study participants had at
least one additional psychiatric disorder.
Combining sertraline and CBT was more effective than treatment
with just one or the other. CBT alone did prove superior to sertraline,
which, in turn, was better than a placebo. By the end of the trial,
the remission rates were 53.6 percent for combined treatment, 39.3
percent for CBT, 21.4 percent for sertraline, and 3.6 percent for
CBT alone was more effective in the University of Pennsylvania
site than at Duke University site, but the combination treatment
was equally effective at both sites, suggesting that it may be
less susceptible to setting-specific variations. The strong showing
of CBT at the University of Pennsylvania led the researchers to
recommend it as “a first line option” for initial treatment.
They point out, however, that “only a small minority” of
children and adolescents with OCD receives such state-of- the-art
“In the Treatment of Adolescents with Depression Study,
which compared CBT with an SSRI and combination treatment, for
teens with depression, the medication proved superior to CBT. In
this case the reverse was true but in both studies, combination
was superior. This underscores that different disorders in adolescents
respond to different treatments,” noted NIMH Director Thomas
“We believe that the results of this study will contribute to
the appreciation by non-physician mental health clinicians of
the strengths and limitations of pharmacological treatments and
to the appreciation by physicians of the evidence-based psychosocial
treatments,” states the article. “It is imperative
that the focus of research turn to identifying and testing dissemination
strategies for CBT,” the researchers add.
There were no episodes of mania, suicidality, or other serious
adverse events during the course of the study.
Also participating in the study were Pat Gammon, Ph.D., Allan
Chrisman, M.D., John Curry, Ph.D., David Fitzgerald, Ph.D., and
Kevin Sullivan, BA, all from Duke University Medical Center; Martin
Franklin, Ph.D., Jonathan Huppert, Ph.D., MoiraRynn, M.D., Ning
Zhao, Ph.D., and Lori Zoellner, Ph.D., from the University of Pennsylvania;
and Henrietta Leonard, M.D., Abbe Garcia, Ph.D., and Jennifer Freeman,
Ph.D., from Brown University. The principal statistician was Xin
Tu, Ph.D. (University of Pennsylvania).
To learn more, visit:
Obsessive Compulsive Disorder (OCD): http://www.nimh.nih.gov/HealthInformation/ocdmenu.cfm
Treatment of Adolescents with Depression Study (TADS): http://www.nimh.nih.gov/press/prtads.cfm
Depression in children and adolescents: http://www.nimh.nih.gov/HealthInformation/depchildmenu.cfm
NIMH is part of the National Institutes of Health (NIH), the Federal
Government's primary agency for biomedical and behavioral research.
NIH is a component of the U.S. Department of Health and Human Services.